What are Nasal Polyps?

Also known as nasal polyposis, these are pale, fleshy, tumor-like masses or polypoidal swellings that develop on the mucosal linings of the nose and the paranasal sinuses. They are noncancerous growths, appearing like peeled grapes or teardrops usually suspended at the area where the sinuses converge with the cavity of the nose. [1, 2, 3]

Image 1: A visibly noticeable nasal polyp found at the left nostril.Source: www.diseasepictures.com

Nasal Polyps: Its Epidemiology

One out of 200 people will have this condition, at most, by the age of forty years. Males have preponderance for the disorder. It occurs among both children and adults. In fact, an estimate of one to four percent of the adults, and less than one percent of children worldwide have nasal polyps. [1, 4, 5]

Causes and Risk Factors for Nasal Polyposis

There is still no definitive etiologic agent known for the development of nasal polyps. However, it is believed that certain conditions can lead to inflammation of nasal mucosa and sinuses, eventually increasing one’s risk of acquiring nasal polyposis. These conditions are as follows:

Cystic Fibrosis

A condition chronically involving organs like lungs, liver, intestines and pancreas, cystic fibrosis is a genetic disorder characterized by abnormal secretion of thickened, sticky fluids. These fluids clog and obstruct the digestive and pulmonary systems, including the sinuses and nasal membranes.

Patients with this disease usually present with persistent cough, salty-tasting skin, frequent bouts of respiratory tract infections, difficulty of breathing, failure to thrive and greasy character of stools. [6, 7, 8]

Hypersensitivity to Aspirin

People with allergic reactions to aspirin and other non steroidal anti inflammatory agents are also more likely to develop these kinds of polyps. This drug intolerance is usually characterized by a pruritic, erythematous rash, alongside wheezing and watery nasal discharge, upon intake of the said drugs. [7]

Bronchial Asthma

Among ten to twenty percent of patients with nasal polyposis also have a history of bronchial asthma. In lieu with this, studies have shown that patients who suffer from asthma are more likely to develop nasal polyps.

Asthma is a disease in which there is overall airway constriction and inflammation. An asthmatic patient would present with on and off attacks of dyspnea and auscultated wheezes. [1, 5, 6, 9]

Churg-Strauss Syndrome

Although an extremely rare disease, half of the population with Churg-Strauss Syndrome also has a concomitant nasal polyposis. This condition is brought about by inflammation of the blood vessels, mostly those at the nose, sinuses, lungs, joints, integuments, gastrointestinal tract, kidneys, heart and the nervous system. It is usually characterized by a number of symptoms, like fever, anorexia, weight loss, difficulty of breathing, rashes, chest pain, nasal discharge, myalgia and arthralgia, abdominal tenderness and numbness. [5, 6, 10]

Allergic Rhinitis

Those with allergic rhinitis are prone to having nasal polyposis. This disorder involves symptoms such as anosmia, pruritic and clogged nose, watery nasal discharge, tearing of eyes, and frequent sneezing bouts. It is usually brought about by allergens such as dust, fur, pollen and insect venom. [7, 11]

Pathogenesis: How These Nasal Polyps Came To Be

A number of mechanisms were postulated to explain how nasal polyps are developed. It had been associated with inflammation, dysregulation of the autonomic nervous system, and genetic acquisition. Among these, however, Bernstein’s theory of inflammation had been the most widely accepted. [5]

According to Bernstein, tumultuous airflow and bacterial or viral-host interaction subsequently leads to inflammation of the nasal wall and sinus mucosa. At the area of turbulent flow of air and that narrowed area of inflamed mucosa, polyps usually form and develop.

This growth is triggered by distinct inflammation of the epithelial cells, fibroblasts and vascular endothelial cells of the nasal mucosa. This consequently increased the absorption of sodium, causing further water retention and subsequent polyp formation. [12, 13]

Symptoms Linked to Nasal Polyposis

Polyps located in the nose do not always produce clinical manifestations. However, with continuous growth, it enlarges in the passageway connecting the nose to the sinuses. As a result, the following conditions can manifest: [1, 14, 15]

Nasal congestion

Either runny water nasal discharge or postnasal drip

Decrease sense of smell

Headache

Snoring during sleep

Frequent sinus infections

Sleep apnea

Facial pain

Decreased gustatory senses

Diplopia

Picture 2 : A few of the signs and symptoms characteristic of nasal polyps: nasal inflammation and runny nose.Source: www.healthcentral.com

Classification of Nasal Polyps

Two major types of nasal polyps exist. They differ in origin, number and location. [2]

Antrochoanal Polyps

These polyps are often unilateral in location, and are single in number. Usually found among children, they root from maxillary sinuses.

Ethmoidal Polyps

In contrast to the previous type, ethmoidal polyps are usually bilateral and are found among adults.

Diagnosing Nasal Polyposis

Aside from history and physical examination, the presence of nasal polyps can be ascertained by a number of diagnostic examinations. [2, 6]

Imaging studies

Using computerized tomography and magnetic resonance imaging, nasal polyp location and size can be determined. These methods can also evaluate the severity of inflammation and further note the condition of the deeper regions of the paranasal sinuses. They can also assist in ruling out the presence of other growths, cancerous or benign ones.

Image 3 : A CT scan imaging shows the presence of multiple nasal polyps, as seen with arrows.Source: www.brown.edu

Nasal Endoscopy

A flexible, narrow tube with an attached small camera is used in this method. It makes a detailed and more accurate examination of the nose and the sinuses possible. The scope is inserted into the nose and guided into the nasal cavity.

Examination for cystic fibrosis

A non-invasive sweat test can confirm the presence of cystic fibrosis. Otherwise known as sweat chloride test, this can measure the concentration of chloride excreted in the sweat. A positive result for cystic fibrosis would have an elevated chloride sweat concentration.

Allergy tests

Skin prick tests are usually done by applying small minute drops of allergens into the integument, either the forearm or back. Within 15 minutes, allergic reactions, particularly the presence of rashes and wheals, are noted for.

Treatment and Surgical Modalities

Options for the management (removal) of nasal polyps include: [15]

Aspirin desensitization for those having hypersensitivity reactions to aspirin can diminish the risk of developing nasal polyps.

Oral corticosteroids, like tablets and syrups, decrease the size of existing polyps. Intranasal corticosteroids also diminish the growth of polyps, decreases sinus infections, and lessen both the use of antibiotics and the options for surgery.

Surgical procedures, such as polypectomy and endoscopic sinus surgery, can be done for polyp removal.